Individual provider Active NPI

Kacey Marie Jacques, PT

  • Physical Therapist
  • Monument, CO
National Provider Identifier
1902128622
Registry record updated Mar 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL0015090 Issued in CO
Practice address
1889 Woodmoor Dr
Monument, CO 80132-9066
Phone
(719) 481-6868
NPI assigned
Feb 22, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical Therapist 2251S0007X 14531 CA
Pediatric Physical Therapist 2251P0200X 14531 CA
Ergonomics Physical Therapist 2251E1200X 14531 CA
Orthopedic Physical Therapist 2251X0800X 14531 CA
Physical Therapist 225100000X PTL0015090 CO Primary

Addresses

Primary practice location

1889 Woodmoor Dr
Monument, CO 80132-9066

Mailing address

6340 Variel Ave
Woodland Hills, CA 91367-2514
Phone (818) 888-1255

Other practice location 1

6340 Variel Ave
Woodland Hills, CA 91367-2514
Phone (818) 888-4559

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111103000773 CA Practitioner - Physical Therapist in Private Practice 5799958997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rehab Specialists IncGroup PAC ID 7810071958, 25 clinicians

Practice addresses (Care Compare)

5359 Balboa Blvd
Suite a
Encino, CA 91316-2834
Phone (310) 273-0877

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTL0015090COMDPhysical Therapist
14531CAMDAcute Care Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1902128622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6340 VARIEL AVE",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913672514",
            "telephone_number": "818-888-1255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1889 WOODMOOR DR",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801329066",
            "telephone_number": "719-481-6868"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6340 Variel Ave",
            "address_purpose": "LOCATION",
            "city": "Woodland Hills",
            "state": "CA",
            "postal_code": "913672514",
            "country_code": "US",
            "telephone_number": "818-888-4559",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "KACEY",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-22",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "CA",
            "license": "14531",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "14531",
            "primary": false
        },
        {
            "code": "2251E1200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Ergonomics",
            "state": "CA",
            "license": "14531",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "14531",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL0015090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monument, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.